Treatment-resistant depression: Causes, symptoms, & support

Key Takeaways

The term “treatment-resistant depression” (TRD) is used to describe severe depression that doesn’t respond to typical treatments. TRD is not a clinical diagnosis.

Living with TRD can be challenging. But people living with TRD can manage their symptoms and find relief with the right support.

Treatment-resistant depression” (TRD) is a form of severe depression that doesn’t respond to typical treatments. In other words, it doesn’t tend to improve with medication or therapy.

While this condition can be difficult to navigate, it’s important to note that those living with TRD can improve their symptoms with a personalized approach. So if you or someone you care about experiences TRD, know that there is hope. A mental health professional can guide you through your treatment options and support you in learning to manage your symptoms.

What is treatment-resistant depression?

People living with TRD experience symptoms similar to major depressive disorder and a persistent form of low-level depression called dysthymia. People living with TRD often experience:

Persistent bouts of sadness and low mood
A loss of motivation and interest in things they used to enjoy
Trouble with sleep and appetite
They may also struggle with focus and may experience thoughts of worthlessness or suicide.

Unlike MDD or dysthymia, symptoms of TRD do not improve with common antidepressant medications or therapy alone. Because TRD is not a clinical diagnosis, it’s difficult to estimate the total number of people who live with this condition. Some research indicates that of the 8.9 million adults with major depressive disorder in the U.S., about 2.8 million of them have TRD.

What causes treatment-resistant depression?

More research is needed to better understand the causes of TRD or “chronic depression.” But some factors may make you more likely to develop this condition, including the following.

Biological factors: Your genetic makeup might make it difficult for your mind and body to respond to certain medications, including antidepressants.
Psychological factors: Having a co-occurring mental health condition like bipolar disorder, substance use disorder, eating disorders, obsessive-compulsive disorder, or panic disorder might make depression more difficult to treat.
Social factors: Living through traumatic events such as childhood abuse or neglect may lead to treatment resistance in people with major depressive disorder.

Common treatment approaches

While there is no cure for depression, including TRD, there are some things you and your provider can explore to help you manage your symptoms, including the following.

Antidepressant medications

At the beginning of your treatment journey, your doctor may prescribe common antidepressants like SSRIs (selective serotonin reuptake inhibitors) or SNRIs (serotonin and norepinephrine reuptake inhibitors). If they aren’t effective right away, you may need to give the medication some time or increase the dose. If antidepressants don’t work for you, it could mean that you have TRD.

Talk therapy

Many people living with TRD find relief from therapy. While individual or group therapy will not totally remove symptoms of TRD, it can be a safe and supportive space to process your experience of TRD and explore new coping strategies.

Lifestyle modifications

Since the hallmark of TRD is that it doesn’t respond to typical approaches to treatment, lifestyle changes are one of the most effective ways to manage it. This might include:

Prioritizing exercise, sleep, and nutrition
Relaxation techniques like meditation or yoga
Setting small goals
Practicing gratitude
Learning to say “no” to things that might overwhelm you or exacerbate your symptoms

Support systems

If you’re living with TRD, it’s important to surround yourself with a support system. This could include friends and family you can talk to when you’re having a hard day and working with a psychiatrist or therapist (or both) to create a treatment plan that works for you. Having to navigate multiple treatment options, some of which have uncomfortable side effects and low success rates, is an incredibly challenging experience. So if you’re struggling right now, know that you’re not alone and that it is possible to improve your symptoms. It might just take some time to find what works best for you. No matter where you are in your treatment journey, remember to have patience and compassion for yourself.

Find support for treatment-resistant depression with Rula

Living with treatment-resistant depression (TRD) can be challenging. At Rula, we’re here to help you find hope in the healing process and make it easier for you to connect with a therapist and a psychiatrist who understands what it’s like to live with TRD. In just a few seconds, we can match you with a provider who specializes in TRD so that you can begin receiving the support you deserve as early as this week.